Meta-Analysis Of The Lipid-Lowering Efficacy And Cardiovascular Safety Of PCSK9 Inhibitors With ACS

Background: Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of death in China and even in the world,Acute coronary syndrome is its most common manifestation,and hypercholesterolemia,Especially,the increase of low density lipoprotein cholesterol(LDL-C)is the most important risk factor in the occurrence and development of ASCVD,and the proprotein convert enzyme subtilisin/kexin type 9,PCSK9)inhibitor has a significant effect on lipid-lowering.this study systematically evaluated the efficacy and safety of PCSK9 inhibitor in reducing lipid in ACS patients by Meta-analysis.Methods: With "PCSK9 inhibitor","alirocumab","evolocumab","acute coronary syndrome","myocardial infarction","unstable angina" and "RCT" as keywords,Chinese and English databases such as CNKI,Wanfang,VIP,CBM,Pubmed,Embase and The Cochrane Library were searched,and the search time was from October 2020.To screen randomized controlled trial(RCT)of patients with ACS treated with PCSK9 inhibitor,and use Stata software random effect model for Meta-analysis.Results: Seven literatures were included in this study,including19574 patients.The drugs in the experimental group included basic standard treatment of Allisy or alirocumab,and the control group was statins,statins combined with other lipid-lowering drugs or other basic standard treatment.In terms of curative effect,PCSK9 inhibitor can further reduce LDL-C(SMD=-1.886,95% CI: [-3.104,-0.667],P=0.002),Triglyceride(TG)(SMD=-0.844,95 P=0.000)and Total cholesterol(TC)concentration(SMD=-2.092,95% ci: [-2.909,-1.276],P=0.000),while high sensitivity c-reactive protein(hscrp)95% CI: [-15,968,2.660],P=0.161)and HDL-C levels were significantly higher than those of the control group(SMD=-0.080,95% CI: [-0.379,0.379,0.01)Compared with the control group,PCSK9 inhibitor has no statistical evidence in improving the incidence of major adverse cardiovascular events(MACEs)in ACS patients(RR=0.952,95%CI:[0.800,1.133],P=0.581).Conclusion: In ACS population,PCSK9 monoclonal antibody can further reduce LDL-C level and improve TG and TC metabolism.In terms of safety,there was no statistically significant difference in the incidence of cardiovascular adverse events between the experimental group and the control group.However,due to the limitation of the number and quality of included studies,the above conclusions still need to be confirmed by high-quality,large-scale randomized controlled trials.